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Photograph by Andrew Harrer/Bloomberg

Many Americans are stuck at home. They aren’t going out to eat. They are focusing their shopping on essentials like cleaning products and groceries. And many aren’t going to their doctor or the local hospital.

Employers and individuals, however, are still paying health insurance premiums. That raises the question of whether health insurers will return, or roll forward, some of the unused money.

Auto insurers including Progressive (ticker: PGR) and State Farm returned a portion of auto premiums to drivers. Miles driven around the U.S. are down to levels not seen since the 1980s. The risk of claims with fewer on the roads has fallen precipitously.

And many health insurers, like their auto peers, are in decent shape. Insurance actuarial services provider Milliman estimated health care spending in the U.S could fall as much as $575 billion in 2020 to roughly $3 trillion from $3.6 trillion In 2019. That means lower costs for health insurance providers—just like few cars on the road means fewer claims for State Farm. For health insurers, that would mean lower medical-loss ratios, or MLRs, or the percentage of premiums that go to cover claims.

“Even with the Covid impact accelerating through [the second quarter], the benefit of weaker utilization and deferral of surgical volumes will more than offset Covid, driving the lowest MLR of the year,” wrote RBC analyst Frank Morgan in an April research report reviewing UnitedHealth Group’s (UNH) solid first-quarter results. “It is looking like the enterprise will perform quite well in 2020, which may explain efforts to increase the flexibility of existing benefits and the consideration of premium rebates or holidays.”

Surprisingly, Insurance companies broached the subject of rebates on first-quarter earnings conference calls. “We have earned above target margins in both 2018 and 2019, and we expected a normalization of that to occur—of our margins to occur here in 2020,” said Anthem (ANTM) CFO John Gallina on the company’s April 29 earnings conference call. “So obviously, regardless of the length or the recovery of the Covid situation, I think individuals are going to have MLR rebates under any circumstance.”

Nor was Anthem alone in discussing the possibility of rebates. “It very well could be that under the circumstances, deferrals of services outweigh Covid-19 costs,” said UnitedHealth CEO David Wichmann on his company’s April 15 earnings conference call. “In those situations, not only would there be normal MLR rebate situations, but we very may well find ourselves in a position where we can provide some additional premium relief to those clients.”

Just how much might come back to individuals and employers isn’t certain. United and Anthem weren’t immediately available for comment.

And not all premiums, or payments received, by health insurers are for insurance. Some are just to access networks. Large companies, oftentimes, take the overall risk of health cost onto their own balance sheets and only want to pay for the negotiated discounts associated with large health care networks. That kind of business is called ASO, or Administrative Services Only. For UnitedHealth, ASO sales represent 5% of total health care premiums.

Large health insurers also do a lot of government business, providing health insurance products for Medicaid and Medicare recipients. That is another portion of the business that doesn’t necessarily apply to the premium-return debate.

For Anthem, government business represents almost 60% of total sales. For Centene (CNC), essentially 100% of its business is Medicaid related.

The companies take different approaches to reporting insurance premiums by segment. Anthem breaks out government business. United reports the insurance premium/ASO split.

Health care was the largest drag on the overall U.S. economy in the first quarter of 2020. The American economy shrank at a 4.8% annual rate over the first three months of the year. Most of the declines came in March when shelter in place mandates ramped up and businesses closed to help slow the spread of the virus. Health care subtracted 2.3 percentage points, or almost half, of the total decline in economic output.

Intensive care units were busy with Covid-19 cases, but the rest of the hospitals were empty, relatively speaking. That will reverse at some point in the coming months, but money left unspent in the first quarter coming back to individuals and employers could represent extra stimulus.

UnitedHealth stock is down about 3% year-to-date, better than comparable drops of the Dow Jones Industrial Average and S&P 500. Anthem shares are down about 11% year-to-date. Centene shares are up 3% year to date.

Write to Al Root at allen.root@dowjones.com